Hornick Jason L, Odze Robert D
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Gastroenterol Clin North Am. 2007 Dec;36(4):775-96, v. doi: 10.1016/j.gtc.2007.08.004.
Barrett's esophagus, currently defined as endoscopically apparent columnar metaplasia of the esophagus with histologic documentation of goblet cells, is the precursor to esophageal adenocarcinoma. However, not all patients with this disorder require intensive surveillance. Pathologic diagnosis and grading of dysplasia in mucosal biopsies remains the best and most widely used method of determining which patients are at highest risk for neoplastic progression. The task of diagnosing dysplasia suffers from considerable interobserver variability. Therefore, consultation with expert gastrointestinal pathologists to confirm the diagnosis of dysplasia before definitive management is highly advisable. Adjunctive methods to improve reproducibility, such as immunostaining for alpha-methylacyl-CoA racemase, show promise but require confirmation in larger studies. This article focuses on dysplasia in Barrett's esophagus in terms of its classification, pathologic diagnostic criteria, limitations, natural history, and treatment.
巴雷特食管目前被定义为内镜下可见的食管柱状上皮化生，并伴有杯状细胞的组织学证据，它是食管腺癌的癌前病变。然而，并非所有患有这种疾病的患者都需要进行强化监测。黏膜活检中发育异常的病理诊断和分级仍然是确定哪些患者发生肿瘤进展风险最高的最佳且应用最广泛的方法。发育异常的诊断工作存在相当大的观察者间差异。因此，在进行明确治疗之前，咨询胃肠病病理专家以确认发育异常的诊断是非常明智的。提高诊断可重复性的辅助方法，如α-甲基酰基辅酶A消旋酶免疫染色，显示出一定前景，但需要在更大规模的研究中得到证实。本文重点探讨巴雷特食管发育异常的分类、病理诊断标准、局限性、自然病程及治疗。
